Driver Employment Application

Authorization

I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application. "I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will may be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand that I have the right to: review information provided by current/previous employers; have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; and have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information."

Personal Information

Current Address

Past Addresses

Employment History

*All applicants wishing to drive in interstate commerce must provide the following information on all employers during the preceding three years. You must give the same information for all employers for whom you have driven a commercial vehicle seven years prior to the initial three years (total of ten year employment record). Any gaps in employment must be explained. The FMCS regulations apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle: 1) weighs or has a GVWR of 10,001 pounds or more, 2) is designed or used to transport 9 or more passengers, or 3) is any size and is used to transport hazardous materials in a quantity requiring placarding.


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License Information

Section 383.21 FMCSR states "No Person who operates a commercial motor vehicle shall at any time have more than one driver’s license". I certify that I do not have more than one motor vehicle license, the information for which is listed below.

Accident Information

If you have had any accidents in the past 3 years, please use the fields below to enter the necessary information.

Accident 1

Accident 2

Accident 3

Traffic Violations Information

If you have had any traffic violations in the past 3 years, please use the fields below to enter the necessary information.

Violation 1

Violation 2

Violation 3

Criminal Information

*This certifies that this was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.